Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Clinical Implementation Science

Background:

• Sepsis management for patients with intermediate lactate values (2-4 mmol/L) lacks defined treatment protocols.
• Hemodynamically stable sepsis patients with intermediate lactate present a unique clinical challenge.
• Existing sepsis guidelines do not specifically address this patient subgroup.

Purpose of the Study:

• To assess the impact of a multicenter treatment bundle implementation for sepsis patients with intermediate lactate.
• To evaluate changes in bundle compliance and patient outcomes post-implementation.
• To specifically analyze outcomes in patients with a history of heart failure and/or chronic kidney disease.

Main Methods:

• A pre- and post-implementation study design was used, analyzing data annually.
• Bundle compliance, hospital mortality, and fluid resuscitation volumes were key outcome measures.
• Multivariable logistic regression analyzed outcomes, with a focus on patients with comorbidities.

Main Results:

• 18,122 patients with intermediate lactate sepsis were identified; 36.1% received care post-bundle implementation.
• Full bundle compliance increased significantly from 32.2% to 44.9% (P<0.01).
• Overall hospital mortality decreased (8.8% to 7.9%, P=0.02), with adjusted odds ratio of 0.81 (P=0.04) post-implementation. Mortality reduction was most pronounced in patients with heart failure/chronic kidney disease history (P<0.01).

Conclusions:

• Multicenter implementation of a sepsis treatment bundle improved compliance and reduced hospital mortality.
• The observed mortality benefit was primarily driven by improved outcomes in patients with heart failure and/or chronic kidney disease.
• Adjustments in fluid resuscitation strategies appear to have played a role in the improved outcomes for high-risk patients.